96 results on '"Lorenzo Scappaticcio"'
Search Results
2. When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes
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Paola Caruso, Maurizio Gicchino, Miriam Longo, Lorenzo Scappaticcio, Ferdinando Campitiello, and Katherine Esposito
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Amputation ,Diabetic foot ,Osteomyelitis ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Abstract Infection is a common complication in patients with diabetic foot ulcer, leading to lower extremities amputation and healing failure. In this article, we report the case of a 39‐year‐old man with diabetes who developed a severe soft tissue infection and osteomyelitis after experiencing a major amputation for wet gangrene of both the foot and the ankle.
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- 2022
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3. SGLT-2 inhibitors and cardiorenal outcomes in patients with or without type 2 diabetes: a meta-analysis of 11 CVOTs
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Dario Giugliano, Miriam Longo, Lorenzo Scappaticcio, Giuseppe Bellastella, Maria Ida Maiorino, and Katherine Esposito
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Cardiovascular outcome trials ,Type 2 diabetes ,SGLT-2 inhibitors ,Cardiorenal outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background It has been suggested that sodium–glucose cotransporter 2 (SGLT-2) inhibitors reduce the cardiorenal risk in patients with type 2 diabetes (T2D). The purpose of this study is to provide an update of all large cardiovascular outcome trials (CVOTs) with SGLT-2 inhibitors to assess their cardiorenal efficacy in patients with and without T2D. Methods An electronic search up to 30 September 2021 was conducted in PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and ClinicalTrials.gov. to determine eligible trials. We included CVOTs comparing any SGLT-2 inhibitor with placebo, reporting desired cardiovascular or renal outcomes and with a follow-up duration of at least 6 months. Results Eleven CVOTs, with data from five SGLT-2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, ertugliflozin and sotagliflozin) and 77,541 participants, were included. In the overall analysis, the risk of the composite CV mortality or hospitalization for heart failure (HF) was reduced by 23% (HR = 0.77, 95% CI 0.73–0.82, P 65 vs ≤ 65 years, P for interaction = 0.78). The risk of CV mortality, total mortality and hospitalization for HF was significantly reduced by 16%, 13%, and 32%, respectively; similarly, the risk of the composite renal outcome was reduced by 35% (HR = 0.65, 95% CI 0.56–0.75), with moderate heterogeneity (I2 = 32%). In the analysis of 6 CVOTs reporting the data, the risk of major cardiovascular events (MACE) was reduced by 12%, with low heterogeneity (I2 = 21.2%, P = 0.19) and irrespective of the presence of established CV disease at baseline (P for interaction = 0.46). Conclusions Therapy with SGLT-2 inhibitors in patients with cardiometabolic and renal diseases results in a sustained to moderate reduction of the composite CV death or hospitalization for HF, robust reduction of HF and renal outcomes, moderate reduction of CV mortality, total mortality and MACE.
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- 2021
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4. GLP-1 receptor agonists vs. SGLT-2 inhibitors: the gap seems to be leveling off
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Dario Giugliano, Lorenzo Scappaticcio, Miriam Longo, Giuseppe Bellastella, and Katherine Esposito
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Type 2 diabetes ,SGLT-2 inhibitors ,GLP-1 receptor agonists ,Cardiorenal benefits ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Cardiovascular disease (CVD) remains the leading cause of death in patients with type 2 diabetes (T2D). Older age, prior heart failure (HF) and CV events, peripheral artery disease, and kidney complications can identify a subgroup of patients with T2D at high risk of mortality who are likely to achieve the greatest benefit from newer glucose-lowering agents. Both glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium-glucose cotransporter-2 (SGLT-2) inhibitors can reduce CV risk in patients with T2D, and both are recommended by the American Diabetes Association to reduce the risk of major cardiovascular events (MACE). The magnitude of the benefits of GLP-1RA and SGLT-2 inhibitors on MACE are similar, ranging from 12 to 14% reduction of risk, but only GLP-1RA may reduce the risk of stroke. The most striking difference between the two classes of drugs relates to the amelioration on hospitalization for HF, as the benefit of SGLT-2 inhibitors surpass by threefold that obtained with GLP-1RA. Despite this, GLP-1RA also exert a significant benefit on HF which suggest their use when SGLT-2 inhibitors are contraindicated or not tolerated. The difference between the two classes is less impressive for the kidney outcome. Overall, the results of CVOTs published so far seems to suggest that the gap between the cardiorenal benefits of SGLT-2 and GLP-1RA is narrowing.
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- 2021
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5. Improvement of glycemic control and reduction of major cardiovascular events in 18 cardiovascular outcome trials: an updated meta-regression
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Maria Ida Maiorino, Miriam Longo, Lorenzo Scappaticcio, Giuseppe Bellastella, Paolo Chiodini, Katherine Esposito, and Dario Giugliano
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Cardiovascular outcome trials ,Type 2 diabetes ,DPP-4i ,GLP-1RA ,SGLT-2i ,Cardiorenal outcomes ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Besides providing reassurance about cardiovascular (CV) safety of newer diabetes drugs, cardiovascular outcome trials (CVOTs) have also shown encouraging benefits on some CV endpoints. The contribution of the better glycemic control in the reduction of major cardiovascular events (MACE) remains an open question. The aim of this study is to evaluate the associations between the reduction of HbA1c and risk of MACE, MACE components, hospitalization for heart failure (HF) and all-cause death in CVOTs. Methods An electronic search up to July 2021 was conducted to determine eligible trials. Systematic review identified eighteen CVOTs reporting prespecified CV outcomes. Pooled summary estimates and 95% confidence intervals (CI) were calculated according to the random effects model using the Paule-Mandel method; restricted maximum likelihood estimators were used to estimate model parameters in the metaregression. Results The eighteen CVOTs evaluated 161,156 patients and included four trials with dipeptidyl-peptidase-4 inhibitors (DPP-4i), eight trials with glucagon-like peptide-1 receptor agonists (GLP-1RA) and six trials with sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Random-effects model meta-analysis showed an association between treatment and risk of MACE (hazard ratio [HR] 0.90; 95% CI 0.86, 0.94, P
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- 2021
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6. GLP-1 receptor agonists and cardiorenal outcomes in type 2 diabetes: an updated meta-analysis of eight CVOTs
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Dario Giugliano, Lorenzo Scappaticcio, Miriam Longo, Paola Caruso, Maria Ida Maiorino, Giuseppe Bellastella, Antonio Ceriello, Paolo Chiodini, and Katherine Esposito
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Cardiovascular outcome trials ,Type 2 diabetes ,GLP-1RA ,Cardiorenal outcomes ,Lixisenatide ,Liraglutide ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background A meta-analysis is presented of cardiovascular outcome trials (CVOTs) comparing glucagon-like peptide-1 receptor agonists (GLP-1RA) versus placebo on cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM). Methods We did an electronic search up to June 30, 2021, for eligible trials. We did a meta-analysis of available trial data using a random-effects model to calculate overall hazard ratios (HRs) and 95% CI (confidence intervals). We included data from 8 CVOTs and 60,080 patients (72.4% with established cardiovascular disease). Results GLP-1RA reduced major cardiovascular events (MACE) by 14% (HR = 0.86, 95% CI 0.79–0.94, P = 0.006) with a non-significant heterogeneity between subgroups of patients with and without cardiovascular disease (P = 0.127). GLP-1RA also reduced the risk of cardiovascular death by 13% (P = 0.016), nonfatal stroke by 16% (P = 0.007), hospitalization for heart failure by 10% (P = 0.023), all-cause mortality by 12% (P = 0.012), and the broad composite kidney outcome by 17% (P = 0.012), which was driven by a reduction in macroalbuminuria only (HR = 0.74, 0.67–0.82, P
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- 2021
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7. Up and down waves of glycemic control and lower-extremity amputation in diabetes
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Paola Caruso, Lorenzo Scappaticcio, Maria Ida Maiorino, Katherine Esposito, and Dario Giugliano
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Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Lower extremity amputations (LEA) are associated with a high mortality and medical expenditure. Diabetes accounts for 45% to 70% of LEA and is one of the most potent risk factors for peripheral artery diseases (PAD). The existence of a link between the recent relaxation of glycemic targets and the resurgence of LEA is suggested from the analysis of adult participants in the National Health and Nutrition Examination Survey (NHANES) between 2010 and 2015, when diabetes-related LEA increased by more than 25% associated with a decline in glycemic control. Indeed, in “the perfect wave” of NHANES, including the years 2007–2010, there was the highest number of diabetic people with hemoglobin A1c (HbA1c), non-high-density lipoprotein (HDL) cholesterol and blood pressure levels at their respective targets, associated with the lowest number of LEA. Until now, the ACCORD study, testing the role of aggressive vs conventional glucose control, and the LEADER trial, evaluating the effects of liraglutide versus placebo, have shown a reduced incidence of LEA in people with type 2 diabetes. The results of ongoing clinical trials involving glucagon-like peptide-1 receptor agonists (GLP-1RA, liraglutide or semaglutide) hopefully will tell us whether the wider use of these drugs may provide additional vascular benefits for diabetic people affected by PAD to decrease their risk of LEA.
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- 2021
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8. Repeat thyroid FNAC: Inter-observer agreement among high- and low-volume centers in Naples metropolitan area and correlation with the EU-TIRADS
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Lorenzo Scappaticcio, Pierpaolo Trimboli, Sergio Iorio, Maria Ida Maiorino, Miriam Longo, Laura Croce, Marcello Filograna Pignatelli, Sonia Ferrandes, Immacolata Cozzolino, Marco Montella, Andrea Ronchi, Renato Franco, Mario Rotondi, Giovanni Docimo, Katherine Esposito, and Giuseppe Bellastella
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thyroid FNAC ,neck ultrasound ,ICCRTC ,EU-TIRADS ,thyroid nodule ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Our institution (University Hospital “L. Vanvitelli” - Naples, Italy) is a high-volume (HV) center in Naples metropolitan area and many patients are referred there to repeat thyroid fine-needle aspiration cytology (FNAC) after initial FNAC performed in low-volume institutions (LV). The aims of the study were to 1) examine the inter-observer agreement between HV and LV institutions according to the Italian thyroid cytology system, and 2) explore how the discordant FNAC reports were distributed in the European Thyroid Imaging and Reporting Data System (EU-TIRADS) categories. All consecutive cases of repeat FNAC performed at University Hospital “L. Vanvitelli” from January 2016 to December 2021 were retrospectively reviewed. Fleiss’ kappa (κ) was used to assess the inter-observer agreement, and categorical variables were compared by chi-square testing. P < 0.05 was considered statistically significant. A total of 124 nodules from 124 adults (mean age 49 years; mean maximum diameter 19 mm) were evaluated. Initial FNAC reports at LV were: 4 (3.2%) TIR1c, 64 (51.6%) TIR2, 48 (38.7%) TIR3A, 8 (6.5%) TIR3B, 0 TIR4, 0 TIR5. The overall FNAC reports were significantly different between the LV and HV institutions. At repeated FNAC, cytological diagnosis was unchanged in 64 (51.6%) cases including TIR2 and TIR3A results. A downgraded FNAC diagnosis (i.e., TIR2 vs TIR3A, TIR2 vs TIR3B) was observed in 36 (29%) nodules. An upgraded FNAC diagnosis (i.e., TIR3B vs TIR2, TIR3B vs TIR3A, TIR4 vs TIR3A, TIR5 vs TIR2, TIR5 vs TIR3B) was recorded in 24 (19.4%) nodules. The weighted inter-observer agreement between LV and HV institutions was poor (κ=0.133). Changed FNAC results were significantly (p=0.0023) more frequent in nodules at intermediate/high-risk (i.e., EU-TIRADS 4/5) than in those at no/low risk (EU-TIRADS 2/3) [i.e., 32/48 (66.7%) and 28/76 (36.8%), respectively]. Downgraded FNAC results were significantly more frequent in EU-TIRADS 2/3 (p=0.001) while upgraded FNAC were present only in EU-TIRADS 4/5 (24/24, 100.0%). The inter-observer agreement among LV and HV thyroid services was poor. The EU-TIRADS 4 and 5 categories included all the malignant nodules with FNAC results reclassified as higher risk (i.e., TIR3B-TIR4-TIR5) by the high-volume cytology service.
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- 2022
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9. Applications for social security benefits related to diabetes in the working age in Italy between 2009 and 2019: a nationwide retrospective cohort study
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Katherine Esposito, Maria Ida Maiorino, Giuseppe Bellastella, Dario Giugliano, Francesco Saverio Mennini, Marco Trabucco Aurilio, Lorenzo Scappaticcio, Miriam Longo, Claudia Nardone, Luca Coppeta, Simone Gazzillo, and Raffaele Migliorini
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Medicine - Published
- 2022
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10. Varicocele: An Endocrinological Perspective
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Giuseppe Bellastella, Raffaela Carotenuto, Francesco Caiazzo, Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Carla Carbone, Davide Arcaniolo, Maria Ida Maiorino, and Katherine Esposito
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varicocele ,hormones ,androgen ,testosterone ,gonadotropins ,Reproduction ,QH471-489 ,Medicine (General) ,R5-920 - Abstract
Varicocele affects 15% of male population but it is more frequently identified in patients searching medical care for infertility. The impact of varicocele on semen production and fertility is known, but the relationship between clinical varicocele and impaired hormonal production is not clear. In published literature there are some studies regarding hormonal alterations in patients with varicocele but no review in which all the hormonal findings are explained. The aim of this review is to evaluate, by most common search engine, what is known about hormonal alterations in varicocele-bearing patients, to verify if a cause-effect relationship is documented and to give a useful contribution to in clinical management of this kind of patients. We found contradictory results about hormonal status from literature. Some studies confirmed a decrease of testosterone levels and higher FSH and LH levels that normalize after varicocelectomy, others found lower than normal levels of dihydrotestosterone due to decreased activity of epididymal 5-α-reductase. Lower circulating Anti-Müllerian Hormone levels, accompanied by a decreased Inhibin-B level, were reported as indicators of the decreased Sertoli cells function in varicocele-bearing adult patients. The finding of higher basal 17-OH-progesterone concentrations in patients with varicocele was explained by some authors with a testicular C-17,20-lyase deficiency. There is no doubt that varicocele could led to hormonal alterations. This review proposes that the impaired free sexual steroid levels are the result of a slight, deep-rooted defect in the testes of a certain amount of men with varicocele but further multicentre, randomized controlled studies remain mandatory to better clarify the hormonal features of patients with varicocele and to assess the utility of hormonal evaluation for establishing the duration of varicocele and for better identifying patients who need surgical correction.
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- 2022
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11. Sodium–glucose transporter-2 inhibitors for prevention and treatment of cardiorenal complications of type 2 diabetes
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Dario Giugliano, Miriam Longo, Lorenzo Scappaticcio, Paola Caruso, and Katherine Esposito
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SGLT-2 inhibitors ,Type 2 diabetes ,MACE ,Heart failure ,Diabetic kidney disease ,Age ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Hospitalization for major diabetes complications, including myocardial infarction, stroke, lower-extremity amputation, and end-stage kidney disease, is on the rise and represents a great health burden for patients with type 2 diabetes (T2D), in particular for older people. Newer glucose-lowering medications have generated some optimism on the possibility to influence the natural history of cardiorenal complications of T2D. This review summarizes work in the area of sodium–glucose cotransporter 2 inhibitors (SGLT-2i) treatment and prevention of cardiorenal complications in patients with T2D (major adverse cardiovascular events, hospitalization for heart failure, kidney outcomes), with a particular emphasis on the effect of age, the role of primary versus secondary prevention and the possible extension of their cardiorenal benefits to the entire class of SGLT-2i.
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- 2021
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12. Neuroimmunoendocrinology of SARS-CoV-2 Infection
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Giuseppe Bellastella, Paolo Cirillo, Carla Carbone, Lorenzo Scappaticcio, Antonietta Maio, Graziella Botta, Maria Tomasuolo, Miriam Longo, Alessandro Pontillo, Antonio Bellastella, Katherine Esposito, and Annamaria De Bellis
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COVID-19 ,hypothalamus ,pituitary gland ,ACTH ,cortisol ,pituitary autoimmunity ,Biology (General) ,QH301-705.5 - Abstract
This review is aimed at illustrating and discussing the neuroimmune endocrinological aspects of the SARS-CoV-2 infection in light of the studies on this topic that have so far appeared in the literature. The most characteristic findings and pending controversies were derived by PubMed and Scopus databases. We included original and observational studies, reviews, meta-analysis, and case reports. The entry of the coronavirus into susceptible cells is allowed by the interaction with an ecto-enzyme located on human cells, the angiotensin-converting enzyme 2 (ACE2). SARS-CoV-2 also targets the central nervous system (CNS), including hypothalamic-pituitary structures, as their tissues express ACE2, and ACE2 mRNA expression in hypothalamus and pituitary gland cells has been confirmed in an autoptic study on patients who died of COVID 19. SARS-CoV-2 infection may cause central endocrine disorders in acute phase and in post-COVID period, particularly due to the effects of this virus at CNS level involving the hypothalamic-pituitary axis. The aggression to the hypothalamus-pituitary region may also elicit an autoimmune process involving this axis, responsible consequently for functional disorders of the satellite glands. Adrenal, thyroid and gonadal dysfunctions, as well as pituitary alterations involving GH and prolactin secretions, have so far been reported. However, the extent to which COVID-19 contributes to short- and long-term effects of infection to the endocrine system is currently being discussed and deserves further detailed research.
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- 2022
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13. Mediterranean Diet and Thyroid: An Interesting Alliance
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Giuseppe Bellastella, Lorenzo Scappaticcio, Francesco Caiazzo, Maria Tomasuolo, Raffaela Carotenuto, Mariangela Caputo, Stefania Arena, Paola Caruso, Maria Ida Maiorino, and Katherine Esposito
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Mediterranean diet ,thyroid function ,thyroid cancer ,thyroid autoimmunity ,Nutrition. Foods and food supply ,TX341-641 - Abstract
The Mediterranean diet, recognized as being cultural heritage by UNESCO, is mostly plant-based and includes a high consumption of whole-grain, fruit, and vegetables with a moderate consumption of alcohol during meals. Thus, it provides a small amount of saturated fatty acids and a high quantity of antioxidants and fiber. For this reason, it has been considered to have an important role in preventing cardiovascular diseases, chronic kidney diseases, type 2 diabetes mellitus, and cancer, but its relationship with thyroid function and diseases is still under debate. The aim of this review was to search for the possible correlation between the Mediterranean diet and thyroid function, and to critically evaluate the pathophysiological link between selected food intake and thyroid disorders.
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- 2022
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14. COVID-19-Associated Subacute Thyroiditis: Evidence-Based Data From a Systematic Review
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Pierpaolo Trimboli, Carlo Cappelli, Laura Croce, Lorenzo Scappaticcio, Luca Chiovato, and Mario Rotondi
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subacute thyroiditis (SAT) ,subacute thyroiditis de Quervain ,SARS-CoV-2 ,COVID-19 ,thyroid ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Subacute thyroiditis (SAT) is a thyroid disease of viral or post-viral origin. Whether SAT represents a complication of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is still unclear. Our aim was to systematically review the literature to 1) explore the size of the literature about SAT in COVID-19 and 2) evaluate the clinical characteristics of SAT. PubMed/MEDLINE, Embase, and Scopus were searched until April 20, 2021. Original papers, case reports, and case series reporting SAT in COVID-19 patients were included. Authors and their country, journal, year of publication, COVID-19 and SAT clinical presentation, thyroid function, therapy, and follow-up data were extracted. Nineteen papers (17 case reports and 2 case series) were included, describing 27 patients, 74.1% females, aged 18 to 69 years. COVID-19 was diagnosed by nasopharyngeal swab in 66.7% cases and required hospitalization in 11.1%. In 83.3% cases, SAT occurred after COVID-19. Neck pain was present in 92.6% cases and fever in 74.1%. Median TSH, fT3, and fT4 were 0.01 mU/l, 10.79 pmol/l, and 27.2 pmol/l, respectively. C-reactive-protein and erythrocyte sedimentation rate were elevated in 96% of cases. Typical ultrasonographic characteristics of SAT were observed in 83.3% of cases. Steroids were the most frequent SAT therapy. Complete remission of SAT was recorded in most cases. In conclusion, the size and quality of published data of SAT in COVID-19 patients are poor, with only case reports and case series being available. SAT clinical presentation in COVID-19 patients seems to be similar to what is generally expected.
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- 2021
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15. European Safety Analysis of mRNA and Viral Vector COVID-19 Vaccines on Glucose Metabolism Events
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Gabriella di Mauro, Annamaria Mascolo, Miriam Longo, Maria Ida Maiorino, Lorenzo Scappaticcio, Giuseppe Bellastella, Katherine Esposito, and Annalisa Capuano
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COVID-19 vaccines ,diabetes mellitus ,glucose metabolism events ,safety ,Europe ,Medicine ,Pharmacy and materia medica ,RS1-441 - Abstract
Few data have been published on the effects of impaired glucose metabolism induced by COVID-19 vaccines. We decided to perform a study to describe Individual Case Safety Reports (ICSRs) of impaired glucose metabolism events reported in the European database (Eudravigilance, EV). ICSRs were retrieved from the online website of Eudravigilance. The reporting odds ratios (ROR) were computed to assess the reporting frequency for COVID-19 mRNA vaccines compared to COVID-19 viral vector-based vaccines. A total of 3917 ICSRs with a COVID-19 vaccine suspected were retrieved, with a total of 4275 impaired glucose metabolism events. Overall, the most reported events were related to “high glucose levels” (2012; 47.06%). The mRNA vaccines were associated with an increased reporting frequency of “type 1 diabetes mellitus” (ROR 1.86; 95% CI 1.33–2.60), “type 2 diabetes mellitus” (ROR 1.58; 95% CI 1.03–2.42), “high glucose levels” (ROR 1.16; 95% CI 1.06–1.27), “diabetes mellitus inadequate control” (ROR 1.63; 95% CI 1.25–2.11), and “hypoglycemia” (ROR 1.62; 95% CI 1.41–1.86) compared to viral vector-based vaccines. mRNA COVID-19 vaccines were associated with an increased reporting frequency of alterations of glucose homeostasis compared to viral-vector COVID-19 vaccines. Clinicians should be aware of these events to better manage glycemic perturbations. Larger nationwide studies are warranted to verify these findings.
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- 2022
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16. Glycemic Control and the Heart: The Tale of Diabetic Cardiomyopathy Continues
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Miriam Longo, Lorenzo Scappaticcio, Paolo Cirillo, Antonietta Maio, Raffaela Carotenuto, Maria Ida Maiorino, Giuseppe Bellastella, and Katherine Esposito
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type 2 diabetes ,diabetic cardiomyopathy ,cardiovascular disease ,heart failure ,glucose control ,glucose-lowering agents ,Microbiology ,QR1-502 - Abstract
Cardiovascular diseases are the leading cause of death in people with diabetes. Diabetic cardiomyopathy (DC) is an important complication of diabetes and represents a distinct subtype of heart failure that occurs in absence of cardiovascular diseases. Chronic hyperglycemia and hyperinsulinemia along with insulin resistance and inflammatory milieu are the main mechanisms involved in the pathophysiology of DC. Changes in lifestyle favoring healthy dietary patterns and physical activity, combined with more innovative anti-diabetes therapies, are the current treatment strategies to safeguard the cardiovascular system. This review aims at providing an updated comprehensive overview of clinical, pathogenetic, and molecular aspects of DC, with a focus on the effects of anti-hyperglycemic drugs on the prevention of pump dysfunction and consequently on cardiovascular health in type 2 diabetes.
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- 2022
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17. Different Formulations of Levothyroxine for Treating Hypothyroidism: A Real-Life Study
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Pierpaolo Trimboli, Lorenzo Scappaticcio, Annamaria De Bellis, Maria Ida Maiorino, Luisa Knappe, Katherine Esposito, Giuseppe Bellastella, and Luca Giovanella
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Objective. Hypothyroid patients are treated by sodium levothyroxine (LT4). Tablet is the mostly used LT4 formulation, and the fasting regimen is required for the absorption of active principle. Also, gastrointestinal diseases and drugs may impair the LT4 bioavailability when tablet is used. Nonsolid LT4 formulations (i.e., liquid solution (LS) and soft gel (SG) capsule) were manufactured to overcome the limitations of LT4 tablet. This study was conceived to evaluate the performance of nonsolid LT4 formulations in a real-life scenario. Methods. Two institutions participated in the study that was conducted in two phases (i.e., enrollment and re-evaluation). Adults with autoimmune or postsurgical hypothyroidism and on LT4 from a few months were selected. A nonparametric statistical analysis for paired or unpaired data was performed. Results. 121 consecutive cases were included. At the enrollment phase, a 52% of patients took the therapy at least 30 min before breakfast with no difference between tablet and SG/LS users. TSH was 1.65 mIU/L (0.86–2.70) in patients on LT4 tablet and 1.70 mIU/L (1.10–2.17) in those on SG/LS (p=0.66). At the re-evaluation phase, among the patients using correct LT4 assumption, the TSH value was stable in the tablet group (p=0.22) and significantly reduced in SG/LS group (p=0.004); among the patients using incorrect LT4 assumption, TSH was significantly increased in those on tablet (p=0.0029) and stable in those on SG/LS (p=0.36). Conclusion. The performance of nonsolid LT4 formulations is not influenced by correct or incorrect use of therapy. On the contrary, LT4 tablet does not guarantee euthyroidism when it is ingested without waiting for at least 30 minutes before breakfast. These new data, obtained in a real-life scenario, suggest that LT4 SG/LS should be regarded as first-line therapy for treating adults with newly diagnosed hypothyroidism.
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- 2020
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18. Exploring the Performance of Ultrasound Risk Stratification Systems in Thyroid Nodules of Pediatric Patients
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Lorenzo Scappaticcio, Maria Ida Maiorino, Sergio Iorio, Giovanni Docimo, Miriam Longo, Anna Grandone, Caterina Luongo, Immacolata Cozzolino, Arnoldo Piccardo, Pierpaolo Trimboli, Emanuele Miraglia Del Giudice, Katherine Esposito, and Giuseppe Bellastella
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pediatric thyroid nodules ,neck ultrasound ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Neck ultrasound (nUS) is the cornerstone of clinical management of thyroid nodules in pediatric patients, as well as adults. The current study was carried out to explore and compare the diagnostic performance of the main US-based risk stratification systems (RSSs) (i.e., the American College of Radiology (ACR), European (EU), Korean (K) TI-RADSs and ATA US RSS criteria) for detecting malignant thyroid lesions in pediatric patients. We conducted a retrospective analysis of consecutive children and adolescents who received a diagnosis of thyroid nodule. We included subjects with age
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- 2021
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19. Hypothalamic–Pituitary Autoimmunity in Patients Treated with Anti-PD-1 and Anti-PD-L1 Antibodies
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Giuseppe Bellastella, Carla Carbone, Lorenzo Scappaticcio, Paolo Cirillo, Teresa Troiani, Floriana Morgillo, Maria Teresa Vietri, Carminia Maria Della Corte, Vincenzo De Falco, Stefania Napolitano, Maria Ida Maiorino, Annamaria De Bellis, and Katherine Esposito
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APA ,anti-pituitary antibodies ,AHA ,anti-hypothalamus antibodies ,pituitary autoimmunity ,anti-PD-1 ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Autoimmune hypophysitis is a frequent immune-related adverse event (irAE) in cancer patients treated with immunecheckpoint inhibitors. Studies seeking anti-pituitary (APA) and anti-hypothalamus (AHA) antibodies in patients treated with anti-PD-1 and anti-PD-L1 are scarce. The aim of this study is to search for APA and AHA and related pituitary dysfunction in patients treated with these agents. Methods:Cross-sectional and preliminary longitudinal studies were conducted at the Medical Oncology Unit and Endocrinology and Metabolic Diseases Unit of the University of Campania “Luigi Vanvitelli”. Fifty-four cancer patients on treatments with anti-PD-1 or anti-PD-L1 (Group 1) and 50 healthy controls were enrolled for a cross-sectional study; 13 cancer patients (Group 2) were enrolled for our preliminary longitudinal study. APA/AHA titers and changes in biochemical and hormonal profile were evaluated in Group 1; in Group 2, they were evaluated before and after nine weeks from the start of immunotherapy. Results: Patients of Group 1 showed a higher prevalence of APA and AHA than controls: 21 of them had APA, 16 had AHA, and 11 had both autoantibodies. In total, 7 of 13 patients in Group 2 became APA-positive and 3 became AHA-positive after nine weeks of immunotherapy, showing an increase in prolactin and a decrease in ACTH and IGF-1 levels compared with basal values. Conclusions:Anti-pituitary and anti-hypothalamus antibodies seem to play a pivotal role in hypothalamic–pituitary autoimmunity and secondary endocrine-related alterations evoked by anti-PD-1 and PD-L1 antibodies.
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- 2021
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20. Chronothyroidology: Chronobiological Aspects in Thyroid Function and Diseases
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Giuseppe Bellastella, Maria Ida Maiorino, Lorenzo Scappaticcio, Annamaria De Bellis, Silvia Mercadante, Katherine Esposito, and Antonio Bellastella
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chronobiology ,biological rhythms ,thyroid diseases ,rhythm disruption ,Science - Abstract
Chronobiology is the scientific discipline which considers biological phenomena in relation to time, which assumes itself biological identity. Many physiological processes are cyclically regulated by intrinsic clocks and many pathological events show a circadian time-related occurrence. Even the pituitary–thyroid axis is under the control of a central clock, and the hormones of the pituitary–thyroid axis exhibit circadian, ultradian and circannual rhythmicity. This review, after describing briefly the essential principles of chronobiology, will be focused on the results of personal experiences and of other studies on this issue, paying particular attention to those regarding the thyroid implications, appearing in the literature as reviews, metanalyses, original and observational studies until 28 February 2021 and acquired from two databases (Scopus and PubMed). The first input to biological rhythms is given by a central clock located in the suprachiasmatic nucleus (SCN), which dictates the timing from its hypothalamic site to satellite clocks that contribute in a hierarchical way to regulate the physiological rhythmicity. Disruption of the rhythmic organization can favor the onset of important disorders, including thyroid diseases. Several studies on the interrelationship between thyroid function and circadian rhythmicity demonstrated that thyroid dysfunctions may affect negatively circadian organization, disrupting TSH rhythm. Conversely, alterations of clock machinery may cause important perturbations at the cellular level, which may favor thyroid dysfunctions and also cancer.
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- 2021
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21. Impact of Pituitary Autoimmunity and Genetic Disorders on Growth Hormone Deficiency in Children and Adults
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Giuseppe Bellastella, Maria Ida Maiorino, Miriam Longo, Paolo Cirillo, Lorenzo Scappaticcio, Maria Teresa Vietri, Antonio Bellastella, Katherine Esposito, and Annamaria De Bellis
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autoimmune ghd ,genetic ghd ,anti-pituitary antibodies ,lymphocytic hypophysitis ,gh insensitivity ,Biology (General) ,QH301-705.5 ,Chemistry ,QD1-999 - Abstract
Growth hormone (GH), mostly through its peripheral mediator, the insulin-like growth factor 1(IGF1), in addition to carrying out its fundamental action to promote linear bone growth, plays an important role throughout life in the regulation of intermediate metabolism, trophism and function of various organs, especially the cardiovascular, muscular and skeletal systems. Therefore, if a prepubertal GH secretory deficiency (GHD) is responsible for short stature, then a deficiency in adulthood identifies a nosographic picture classified as adult GHD syndrome, which is characterized by heart, muscle, bone, metabolic and psychic abnormalities. A GHD may occur in patients with pituitary autoimmunity; moreover, GHD may also be one of the features of some genetic syndromes in association with other neurological, somatic and immune alterations. This review will discuss the impact of pituitary autoimmunity on GHD and the occurrence of GHD in the context of some genetic disorders. Moreover, we will discuss some genetic alterations that cause GH and IGF-1 insensitivity and the arguments in favor and against the influence of GH/IGF-1 on longevity and cancer in the light of the papers on these issues that so far appear in the literature.
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- 2020
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22. Change in Circulating Levels of Endothelial Progenitor Cells and Sexual Function in Women With Type 1 Diabetes
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Antonietta Maio, Maria Ida Maiorino, Miriam Longo, Lorenzo Scappaticcio, Vlenia Pernice, Paolo Cirillo, Paola Caruso, Vanda Amoresano Paglionico, Giuseppe Bellastella, Katherine Esposito, Maio, Antonietta, Maiorino, Maria Ida, Longo, Miriam, Scappaticcio, Lorenzo, Pernice, Vlenia, Cirillo, Paolo, Caruso, Paola, Paglionico, Vanda Amoresano, Bellastella, Giuseppe, and Esposito, Katherine
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type 1 diabetes ,Endocrinology, Diabetes and Metabolism ,Biochemistry (medical) ,Clinical Biochemistry ,sexual function ,Antigens, CD34 ,Flow Cytometry ,Biochemistry ,menstrual cycle ,Diabetes Mellitus, Type 1 ,endothelial progenitor cell ,Endocrinology ,Case-Control Studies ,cardiovascular system ,Humans ,Female ,Endothelial Progenitor Cells - Abstract
Context Endothelial progenitor cells (EPCs), which are involved in the mechanisms of vascular repair and sexual function, are decreased in diabetic women compared with general population. Objective This work aimed to investigate the circulating levels of EPCs and the change in sexual function during the menstrual cycle in women with type 1 diabetes (T1DM) compared with healthy women. Methods This case-control observational study was conducted at the Unit of Endocrinology and Metabolic Diseases at University Hospital “Luigi Vanvitelli’’ of Naples. Participants included 36 women with T1DM and 64 age-matched healthy controls. EPCs were quantified by flow cytometry and sexual function was assessed using the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale. All assessments were made at the follicular, ovulatory, and luteal phases of the same menstrual cycle. Main outcome measures included differences in EPCs levels and sexual function between patients and controls. Results Compared with controls, women with T1DM showed significantly lower levels of both CD34 + (P Conclusion Women with T1DM show lower levels of EPCs during the menstrual cycle compared with controls. EPCs count predicts sexual function in this selected population.
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- 2022
23. Suboptimal accuracy of ultrasound and ultrasound‐based risk stratification systems in detecting medullary thyroid carcinoma should not be overlooked. Findings from a systematic review with meta‐analysis
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Giulia Ferrarazzo, Chiara Camponovo, Maurilio Deandrea, Arnoldo Piccardo, Lorenzo Scappaticcio, and Pierpaolo Trimboli
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Endocrinology ,Endocrinology, Diabetes and Metabolism ,Humans ,Thyroid Neoplasms ,Thyroid Nodule ,Risk Assessment ,Carcinoma, Neuroendocrine - Abstract
Ultrasound (US) is the pivotal procedure during the diagnostic work-up of thyroid nodule and several US-based risk stratification systems (RSSs) have been recently developed. Since the performance of RSSs in detecting medullary thyroid carcinoma (MTC) has been rarely investigated, the present systematic review aimed to achieve high evidence about (1) how MTC is classified according to RSSs; (2) if RSSs correctly classify MTC at high risk/suspicion, and (3) if MTC is classified as suspicious at US when RSSs are not used.The review was performed according to MOOSE. The online search was performed by specific algorithm on January 2022. A random-effects model was used for statistical analysis.Twenty-five papers were initially included and their risk of bias was generally low. According to ATA system, 65% of MTCs was assessed at high suspicion and 25% at intermediate suspicion. Considering all RSSs, a 54.8% of MTCs was put in a high-risk/suspicion category. Pooling data from studies without data of RSS the prevalence of ultrasonographically suspicious MTCs was 60%.As conclusion, MTC presentation according to RSSs is partially known and it is classified in a high-risk/suspicion category of RSSs in just over a half of cases. This advises for further studies, ideally supported by international societies, to better define the US presentation of MTC.
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- 2022
24. Biochemical predictors of diabetic foot osteomyelitis: A potential diagnostic role for parathormone
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Paola Caruso, Maria Ida Maiorino, Lorenzo Scappaticcio, Chiara Porcellini, Rita Matrone, Paolo Cirillo, Margherita Macera, Maurizio Gicchino, Maria Teresa Vietri, Giuseppe Bellastella, Nicola Coppola, Katherine Esposito, Caruso, Paola, Maiorino, Maria Ida, Scappaticcio, Lorenzo, Porcellini, Chiara, Matrone, Rita, Cirillo, Paolo, Macera, Margherita, Gicchino, Maurizio, Vietri, Maria Teresa, Bellastella, Giuseppe, Coppola, Nicola, and Esposito, Katherine
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parathormone ,Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,osteomyeliti ,tertiary-care center ,diabetic foot ulcer ,Type 2 diabete - Abstract
The aims of this study were to evaluate parathormone (PTH) levels in people with diabetic foot ulcers (DFU) and investigate the relationship between PTH levels and osteomyelitis (OM) in this population.Eighty-eight patients were admitted for DFU in a tertiary-care centre from October 2021 to May 2022. OM was diagnosed by clinical, laboratory, and radiological evaluations. Laboratory measurements and clinical parameters were collected from medical records. Participants in the study were divided into two groups according to the diagnosis of OM (patients with OM, group 1 [n = 54] and patients without OM, group 2 [n = 34]).Compared with group 2, patients in group 1 were younger and had a longer duration of diabetes. Erythrocyte sedimentation rate and fibrinogen were significantly higher in group 1 compared with group 2. PTH levels were significantly lower (group 1 vs. group 2, median [interquartile range] 16.2 (11.6, 31.0) vs. 23.7 (17.0, 38.1), p = 0.008) and alkaline phosphatase was significantly higher (97.0 (79.0, 112.0) vs. 88.0 (63.0, 107.0), p = 0.031) in group 1. In multiple linear regression analysis, the only independent predictors of PTH concentrations were alkaline phosphatase levels (β-coefficient 0.441, p 0.001) and the presence of OM (β-coefficient -0.290, p = 0.038).In a population of patients with diabetes and OM admitted to a tertiary university centre, PTH levels were lower as compared with diabetic individuals without OM. The OM and alkaline phosphatase levels were independent predictors of PTH levels in this selected population.
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- 2023
25. Improvement of glycemic control and reduction of major cardiovascular events in 18 cardiovascular outcome trials: an updated meta-regression
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Lorenzo Scappaticcio, Katherine Esposito, Giuseppe Bellastella, Maria Ida Maiorino, Paolo Chiodini, Dario Giugliano, Miriam Longo, Maiorino, M. I., Longo, M., Scappaticcio, L., Bellastella, G., Chiodini, P., Esposito, K., and Giugliano, D.
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Blood Glucose ,Male ,Time Factors ,Endocrinology, Diabetes and Metabolism ,Meta-regression ,Type 2 diabetes ,Review ,DPP-4i ,Cardiovascular outcome trials ,Glycemic control ,Risk Factors ,Cause of Death ,Stroke ,Randomized Controlled Trials as Topic ,Hazard ratio ,Cardiorenal outcome ,Middle Aged ,GLP-1RA ,Hospitalization ,Treatment Outcome ,Cardiovascular Diseases ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,MACE ,Incretins ,Risk Assessment ,Glucagon-Like Peptide-1 Receptor ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Diseases of the circulatory (Cardiovascular) system ,Sodium-Glucose Transporter 2 Inhibitors ,Glycemic ,Aged ,Glycated Hemoglobin ,Dipeptidyl-Peptidase IV Inhibitors ,business.industry ,Cardiorenal outcomes ,SGLT-2i ,Protective Factors ,medicine.disease ,Confidence interval ,Cardiovascular outcome trial ,Diabetes Mellitus, Type 2 ,RC666-701 ,business ,Mace ,Biomarkers - Abstract
Background Besides providing reassurance about cardiovascular (CV) safety of newer diabetes drugs, cardiovascular outcome trials (CVOTs) have also shown encouraging benefits on some CV endpoints. The contribution of the better glycemic control in the reduction of major cardiovascular events (MACE) remains an open question. The aim of this study is to evaluate the associations between the reduction of HbA1c and risk of MACE, MACE components, hospitalization for heart failure (HF) and all-cause death in CVOTs. Methods An electronic search up to July 2021 was conducted to determine eligible trials. Systematic review identified eighteen CVOTs reporting prespecified CV outcomes. Pooled summary estimates and 95% confidence intervals (CI) were calculated according to the random effects model using the Paule-Mandel method; restricted maximum likelihood estimators were used to estimate model parameters in the metaregression. Results The eighteen CVOTs evaluated 161,156 patients and included four trials with dipeptidyl-peptidase-4 inhibitors (DPP-4i), eight trials with glucagon-like peptide-1 receptor agonists (GLP-1RA) and six trials with sodium-glucose cotransporter-2 inhibitors (SGLT-2i). Random-effects model meta-analysis showed an association between treatment and risk of MACE (hazard ratio [HR] 0.90; 95% CI 0.86, 0.94, P 2 = 45.2%, Q statistic P = 0.040). In meta-regression, there was an association between the reduction in HbA1c at the end of the trial and the HR reduction for MACE (beta = − 0.298, P = 0.007), with significant heterogeneity (I2 = 40%, Q statistic P = 0.04); this association was totally driven by the risk reduction of non-fatal stroke, which explained 100% of between-study variance (beta = − 0.531, R2 = 100%), without heterogeneity (I2 = 24%, Q statistic P = 0.206). There was no association between the reduction in HbA1c and the HR for heart failure or all-cause death. Conclusions The reduction of HbA1c in eighteen CVOTs was significantly associated with reduction of non-fatal stroke, explaining all (R2 = 100%) of the between-study variance. While the contribution of glucose lowering in some CV benefits of newer agents does not influence their indications for the patient with type 2 diabetes, it may hopefully facilitate their use.
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- 2021
26. Circulating levels of endothelial progenitor cells are associated with better cognitive function in older adults with glucagon-like peptide 1 receptor agonist-treated type 2 diabetes
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Miriam Longo, Irene Di Meo, Paola Caruso, Maria Francesca Muscio, Lorenzo Scappaticcio, Antonietta Maio, Maria Ida Maiorino, Giuseppe Bellastella, Giuseppe Signoriello, Filip K. Knop, Maria Rosaria Rizzo, and Katherine Esposito
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Endocrinology ,Endocrinology, Diabetes and Metabolism ,Internal Medicine ,General Medicine - Published
- 2023
27. Feasibility of Simplification From a Basal-Bolus Insulin Regimen to a Fixed-Ratio Formulation of Basal Insulin Plus a GLP-1RA or to Basal Insulin Plus an SGLT2 Inhibitor: BEYOND, a Randomized, Pragmatic Trial
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Maria Ida Maiorino, Rosa Di Fraia, Paola Caruso, Miriam Longo, Lorenzo Scappaticcio, Michela Petrizzo, Maurizio Gicchino, Katherine Esposito, Giuseppe Bellastella, Dario Giugliano, Giugliano, D., Longo, M., Caruso, P., Di Fraia, R., Scappaticcio, L., Gicchino, M., Petrizzo, M., Bellastella, G., Maiorino, M. I., and Esposito, K.
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Blood Glucose ,medicine.medical_specialty ,Glycated Hemoglobin A ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,030209 endocrinology & metabolism ,Type 2 diabetes ,Hypoglycemia ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Glucagon-Like Peptide 1 ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,Medicine ,Humans ,Hypoglycemic Agents ,Insulin ,030212 general & internal medicine ,Sodium-Glucose Transporter 2 Inhibitors ,Glycemic ,Advanced and Specialized Nursing ,Glycated Hemoglobin ,Hypoglycemic Agent ,Emerging Therapies: Drugs and Regimens ,business.industry ,medicine.disease ,Feasibility Studie ,Regimen ,Endocrinology ,Diabetes Mellitus, Type 2 ,Feasibility Studies ,business ,Gliflozin ,Human ,medicine.drug - Abstract
OBJECTIVE BEYOND trial evaluated the feasibility of either basal insulin plus glucagon-like peptide 1 receptor agonist (GLP-1RA) or basal insulin plus sodium–glucose cotransporter 2 inhibitor (SGLT2i) to replace a full basal-bolus insulin (BBI) regimen in participants with type 2 diabetes and inadequate glycemic control. RESEARCH DESIGN AND METHODS Participants were randomized (1:1:1) to: 1) intensification of the BBI regimen (n = 101), 2) fixed ratio of basal insulin plus GLP-1RA (fixed-combo group; n = 102), and 3) combination of basal insulin plus SGLT2i (gliflo-combo group; n = 102). The primary efficacy outcome was change from baseline in HbA1c at 6 months. RESULTS Baseline characteristics were similar among the three groups (mean HbA1c was 8.6% [70 mmol/mol]). At 6 months, patients experienced similar reduction in HbA1c level (−0.6 ± 0.8, −0.6 ± 0.8, and −0.7 ± 0.9%, mean ± SD, respectively; noninferiority P < 0.001 vs. BBI), and the proportion of patients with HbA1c ≤7.5% was also similar (34%, 28%, and 27%, respectively; P = 0.489). Total insulin dose increased in the BBI group (62 units/day) and decreased both in the fixed-combo and gliflo-combo groups (27 units/day and 21 units/day, respectively; P < 0.01). The proportion of patients with hypoglycemia was 17.8%, 7.8%, and 5.9%, respectively (P = 0.015). There were 12 dropouts in the fixed-combo group, 9 in the gliflo-combo group, and none in the BBI group. CONCLUSIONS BEYOND provides evidence that it is possible and safe to switch from a BBI regimen to either a once-daily fixed-combo injection or once-daily gliflozin added to basal insulin, with similar glucose control, fewer insulin doses, fewer injections daily, and less hypoglycemia.
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- 2021
28. Applications for social security benefits related to diabetes in the working age in Italy between 2009 and 2019: a nationwide retrospective cohort study
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Marco Trabucco Aurilio, Maria Ida Maiorino, Francesco Saverio Mennini, Lorenzo Scappaticcio, Miriam Longo, Claudia Nardone, Luca Coppeta, Simone Gazzillo, Raffaele Migliorini, Giuseppe Bellastella, Dario Giugliano, Katherine Esposito, Trabucco Aurilio, Marco, Maiorino, Maria Ida, Mennini, Francesco Saverio, Scappaticcio, Lorenzo, Longo, Miriam, Nardone, Claudia, Coppeta, Luca, Gazzillo, Simone, Migliorini, Raffaele, Bellastella, Giuseppe, Giugliano, Dario, and Esposito, Katherine
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EPIDEMIOLOGY ,General diabetes ,Health policy ,Humans ,Income ,Pensions ,Retrospective Studies ,Diabetes Mellitus ,Social Security ,Pension ,Diabetes Mellitu ,General Medicine ,General diabete ,Retrospective Studie ,Human - Abstract
ObjectivesThe aim of this study is to estimate the average number of claims for social security benefits from workers with diabetes-related disability.DesignNationwide retrospective cohort study.SettingThe database of the Italian Social Security Institute (INPS) was used to analyse the trends and the breakdown of all claims for social security benefit with diabetes as primary diagnosis from 2009 to 2019.ParticipantsWe selected all the applications with the 250.xx International Classification of Diseases, Ninth Revision-CM diagnosis code from 2009 to 2019.Primary and secondary outcome measuresThe ratio between accepted or rejected claims for both ordinary incapacity benefit (OIB) and disability pension (DP) and total submitted claims over a 10-year period was computed.ResultsFrom 2009 to 2019, 40 800 applications for social security benefits were filed with diabetes as the principal diagnosis, with an annual increase of 30% per year. Throughout the study decade, there was a higher rate of rejected (67.2%) than accepted (32.8%) applications. Among the accepted requests, most of them (30.7%) were recognised as OIB and the remaining 2.1% were recognised as DP. When related to the total number of claims presented per year, there was a 8.8% decrease of rejected applications, associated with a 20.6% increase of overall acceptance rate. In terms of time trends, the overall rise of submitted requests from 2009 to 2019 resulted in an increase in both rejected (+18%) and accepted (+61% for OIB, +11% for DP) applications. The higher rate of accepted requests was for workers aged 51–60 years, with 52% of admitted applications.ConclusionsBetween 2009 and 2019, the number of applications for social security benefits due to diabetes in Italy increased significantly, and so did the number of applications approved, mainly represented by the OIBs.
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- 2022
29. Thymic hyperplasia associated with Graves' Disease: lessons from the resolution of six individual cases
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Lorenzo Scappaticcio, Pierpaolo Trimboli, Sergio Iorio, Alfredo Clemente, Francesco Caiazzo, Fraia Rosa Di, Selvaggio Lucia Digitale, Lorenzo Concetta Di, Claudia Varro, Giuseppe Bellastella, Mariaida Maiorino, and Katherine Esposito
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- 2022
30. Repeating thyroid FNAC: inter-observer agreement among high- and low-volume thyroid services in Naples metropolitan area and correlation with the EU-TIRADS
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Lorenzo Scappaticcio, Pierpaolo Trimboli, Sergio Iorio, Stefania Arena, Martino Nicole Di, Annarita Palmieri, Katherine Esposito, and Giuseppe Bellastella
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- 2022
31. Dati evidence-based sulla affidabilità dei sistemi ecografici per la stratificazione del rischio di malignità del nodulo tiroideo (TIRADS)
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Lorenzo Scappaticcio, Marco Castellana, and Pierpaolo Trimboli
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03 medical and health sciences ,0302 clinical medicine ,Geography ,030220 oncology & carcinogenesis ,030209 endocrinology & metabolism ,Humanities - Abstract
SommarioL’esame strumentale più comunemente utilizzato per valutare il rischio di malignità del nodulo tiroideo è l’ecografia. Con questo esame è possibile individuare posizione, dimensioni e caratteristiche del nodulo. Dal momento che l’uso dei singoli aspetti ecografici di sospetto ha dimostrato una bassa riproducibilità nell’indicazione all’agoaspirato, nel corso degli ultimi anni sono stati sviluppati diversi sistemi per la stratificazione del rischio ecografico di malignità (Thyroid Image And Reporting Data Systems, TIRADS). Nella presente rassegna vengono riportati e discussi alcuni recenti studi relativi all’affidabilità dei sistemi ecografici.
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- 2022
32. Impact of COVID-19 on the thyroid gland: an update
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Lorenzo Scappaticcio, Arnoldo Piccardo, Katherine Esposito, Fabián Pitoia, Pierpaolo Trimboli, Scappaticcio, L., Pitoia, F., Esposito, K., Piccardo, A., and Trimboli, P.
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Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Systemic inflammation ,Bioinformatics ,TMPRSS2 ,Hyperthyroidism ,Virus ,Article ,Thyroid cancer ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Hypothyroidism ,Diabetes mellitus ,medicine ,Humans ,Pandemics ,Thyroid ,business.industry ,SARS-CoV-2 ,COVID-19 ,medicine.disease ,Thyroid Diseases ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine.symptom ,business - Abstract
Coronavirus disease 2019 (COVID-19) is the pandemic of the new millennium. COVID-19 can cause both pulmonary and systemic inflammation, potentially determining multi-organ dysfunction. Data on the relationship between COVID-19 and thyroid have been emerging, and rapidly increasing since March 2020. The thyroid gland and the virus infection with its associated inflammatory-immune responses are known to be engaged in complex interplay. SARS-CoV-2 uses ACE2 combined with the transmembrane protease serine 2 (TMPRSS2) as the key molecular complex to infect the host cells. Interestingly, ACE2 and TMPRSS2 expression levels are high in the thyroid gland and more than in the lungs. Our literature search provided greater evidence that the thyroid gland and the entire hypothalamic–pituitary–thyroid (HPT) axis could be relevant targets of damage by SARS-CoV-2. Specifically, COVID-19-related thyroid disorders include thyrotoxicosis, hypothyroidism, as well as nonthyroidal illness syndrome. Moreover, we noticed that treatment plans for thyroid cancer are considerably changing in the direction of more teleconsultations and less diagnostic and therapeutical procedures. The current review includes findings that could be changed soon by new results on the topic, considering the rapidity of worldwide research on COVID-19.
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- 2022
33. When amputation is not the end of the challenge: A successful therapy for osteomyelitis and soft tissue infection in a patient with type 1 diabetes
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Miriam Longo, Katherine Esposito, Ferdinando Campitiello, Lorenzo Scappaticcio, Paola Caruso, Maurizio Gicchino, Caruso, P., Gicchino, M., Longo, M., Scappaticcio, L., Campitiello, F., and Esposito, K.
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Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Case Report ,Diseases of the endocrine glands. Clinical endocrinology ,Gangrene ,Diabetes mellitus ,Anti-Bacterial Agent ,Medical Illustration ,Internal Medicine ,medicine ,Osteomyeliti ,Amputation ,Soft Tissue Infection ,Type 1 diabetes ,business.industry ,Osteomyelitis ,General Medicine ,RC648-665 ,medicine.disease ,Diabetic foot ,Surgery ,Clinical Science and Care ,Diabetic foot ulcer ,medicine.anatomical_structure ,Diabetes Mellitus, Type 1 ,Treatment Outcome ,Debridement ,Postoperative Complication ,Ankle ,Complication ,business ,Human - Abstract
Infection is a common complication in patients with diabetic foot ulcer, leading to lower extremities amputation and healing failure. In this article, we report the case of a 39‐year‐old man with diabetes who developed a severe soft tissue infection and osteomyelitis after experiencing a major amputation for wet gangrene of both the foot and the ankle.
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- 2022
34. Assessment of Neuroendocrine Changes and Hypothalamo-Pituitary Autoimmunity in Patients with COVID-19
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Mustafa Sait Gonen, Annamaria De Bellis, Emre Durcan, Giuseppe Bellastella, Paolo Cirillo, Lorenzo Scappaticcio, Miriam Longo, Basak Ecem Bircan, Serdar Sahin, Cem Sulu, Hande Mefkure Ozkaya, Dildar Konukoglu, Fatma Ferda Kartufan, Fahrettin Kelestimur, Gonen, Mustafa Sait, De Bellis, Annamaria, Durcan, Emre, Bellastella, Giuseppe, Cirillo, Paolo, Scappaticcio, Lorenzo, Longo, Miriam, Bircan, Basak Ecem, Sahin, Serdar, Sulu, Cem, Ozkaya, Hande Mefkure, Konukoglu, Dildar, Kartufan, Fatma Ferda, and Kelestimur, Fahrettin
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Adult ,Male ,Hydrocortisone ,Endocrinology, Diabetes and Metabolism ,Clinical Biochemistry ,Hypothalamus ,Autoimmunity ,ACTH stimulation test ,Biochemistry ,antipituitary antibodie ,Endocrinology ,Adrenocorticotropic Hormone ,Hypothalamu ,Humans ,Testosterone ,Prospective Studies ,Insulin-Like Growth Factor I ,Autoantibodies ,SARS-CoV-2 ,Biochemistry (medical) ,COVID-19 ,General Medicine ,Middle Aged ,Autoantibodie ,Prolactin ,antihypothalamic antibodie ,Prospective Studie ,Case-Control Studies ,Pituitary Gland ,hypothalamic-pituitary axi ,Female ,adrenal insufficiency ,Case-Control Studie ,Human - Abstract
SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, in particular, secondary adrenal insufficiency, using a dynamic test and the role of autoimmunity in pituitary dysfunction in patients with COVID-19. The single-center, prospective, case-control study included patients with polymerase chain reaction (PCR)-confirmed COVID-19 and healthy controls. Basal hormone levels were measured, and the adrenocorticotropic hormone (ACTH) stimulation test was performed. Antipituitary (APA) and antihypothalamic antibodies (AHA) were also determined. We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. Patients with COVID-19 had lower free T3, IGF-1, and total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. In conclusion, COVID-19 may result in adrenal insufficiency, thus routine screening of adrenal functions in these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormalities in COVID-19.
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- 2022
35. Thyroid surgery during the COVID-19 pandemic: results from a systematic review
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C Camponovo, Lorenzo Scappaticcio, Arnoldo Piccardo, Pierpaolo Trimboli, Katherine Esposito, Giovanni Docimo, Giuseppe Bellastella, Maria Ida Maiorino, Sergio Iorio, Scappaticcio, L., Maiorino, M. I., Iorio, S., Camponovo, C., Piccardo, A., Bellastella, G., Docimo, G., Esposito, K., and Trimboli, P.
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Adult ,Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Hypoparathyroidism ,Endocrinology, Diabetes and Metabolism ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Thyroid Disease ,MEDLINE ,030209 endocrinology & metabolism ,Comorbidity ,Malignancy ,Laryngeal Nerve Injuries ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Endocrinology ,Pandemic ,medicine ,Humans ,Thyroid Neoplasms ,Lymph node ,Thyroid Neoplasm ,Aged ,Thyroid ,Aged, 80 and over ,Cross Infection ,Elective Surgical Procedure ,business.industry ,SARS-CoV-2 ,COVID-19 ,Middle Aged ,medicine.disease ,Thyroid Diseases ,Surgery ,medicine.anatomical_structure ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Thyroidectomy ,Lymph Node Excision ,Original Article ,Female ,Laryngeal Nerve Injurie ,Postoperative Complication ,business ,Human - Abstract
Purpose During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. Methods We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ‘‘Thyroid’’ and “coronavirus” as search terms. Results Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2–3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. Conclusion The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.
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- 2022
36. Neutropenia in patients with hyperthyroidism: Systematic review and meta‐analysis
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Katherine Esposito, Giuseppe Bellastella, Antonietta Maio, Maria Ida Maiorino, Lorenzo Scappaticcio, Scappaticcio, L., Maiorino, M. I., Maio, A., Esposito, K., and Bellastella, G.
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medicine.medical_specialty ,Pediatrics ,Neutropenia ,white blood cells ,Neutrophils ,Endocrinology, Diabetes and Metabolism ,Graves' disease ,030209 endocrinology & metabolism ,Hyperthyroidism ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,hemic and lymphatic diseases ,Internal medicine ,Prevalence ,medicine ,Forest plot ,Humans ,Contraindication ,business.industry ,Publication bias ,medicine.disease ,Graves Disease ,Confidence interval ,030220 oncology & carcinogenesis ,Meta-analysis ,Absolute neutrophil count ,Graves’ disease ,business - Abstract
Background and Objective: Neutropenia, a low absolute neutrophil count (ANC), may be a sign of new-onset hyperthyroidism. The aim of this systematic review and meta-analysis was to provide the most reliable estimates of prevalence, degree and response to treatments of neutropenia in the pure hyperthyroidism setting. Methods: A comprehensive literature search was performed in PubMed and Scopus databases for retrieving articles in English and non-English languages reporting ANC values/neutropenic cases at presentation and after therapy in patients with hyperthyroidism. A proportion meta-analysis was performed with DerSimonian and Laird method (random-effects model). Pooled data were presented with 95% confidence intervals (95% CI) and displayed in a forest plot. I2 statistic index was used to quantify the heterogeneity among the studies. Sensitivity analyses for the prevalence of neutropenia and the mean of ANC in hyperthyroid patients were performed by excluding the studies without full details. Trim and fill analysis and Egger's linear regression test were carried out to evaluate the publication bias. A two-sided P-value of
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- 2020
37. Graves’ hyperthyroidism-related pancytopenia: a case report with literature review
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Giuseppe Paolisso, Lorenzo Scappaticcio, Maria Ida Maiorino, Maria Rosaria Rizzo, Claudia Catalano, Katherine Esposito, Giuseppe Bellastella, Miriam Longo, Scappaticcio, L., Bellastella, G., Maiorino, M. I., Longo, M., Catalano, C., Esposito, K., Paolisso, G., and Rizzo, M. R.
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Male ,Pediatrics ,medicine.medical_specialty ,endocrine system diseases ,Pancytopenia ,Graves hyperthyroidism ,Endocrinology, Diabetes and Metabolism ,Graves' disease ,030209 endocrinology & metabolism ,Context (language use) ,Review ,Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Methimazole ,0302 clinical medicine ,Antithyroid Agents ,hemic and lymphatic diseases ,Humans ,Medicine ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Graves Disease ,Liver dysfunction ,Graves’ disease ,business ,Complication ,medicine.drug - Abstract
Introduction: Occurrence of pancytopenia in patients with untreated hyperthyroidism is extremely rare. To the best of our knowledge, only 30 cases have been reported in the English literature. Accurate diagnosis and appropriate tailored therapy are challenging due to the variegated causes of pancytopenia and the potential hematological toxicity of antithyroid drugs (ATDs). Case report: We present a 51-year-old Caucasian man with newly diagnosed Graves’ disease showing pancytopenia and liver dysfunction. Although in this context the use of ATDs is still under debate, low-dose methimazole therapy was able to induce resolution of both pancytopenia and liver dysfunction, along with euthyroidism restoration. Conclusion: Searching in the English literature for previous studies, we identified only 30 cases worldwide to form our database. A demographic as well as clinical, laboratory, and histopathological analysis was performed. In most cases, the recovery of biochemical euthyroidism through the use of ATDs induced the resolution of pancytopenia (at laboratory and histological levels). Our review provides clinical, laboratory, and histopathological features of Graves’s hyperthyroidism-related pancytopenia with a view to improving the knowledge of this rare hematological complication and assisting in the decision-making process regarding therapeutic options.
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- 2020
38. Different Formulations of Levothyroxine for Treating Hypothyroidism: A Real-Life Study
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Luca Giovanella, Lorenzo Scappaticcio, Maria Ida Maiorino, Annamaria De Bellis, Pierpaolo Trimboli, Katherine Esposito, Giuseppe Bellastella, Luisa Knappe, Trimboli, P., Scappaticcio, L., De Bellis, A., Maiorino, M. I., Knappe, L., Esposito, K., Bellastella, G., and Giovanella, L.
- Subjects
endocrine system ,medicine.medical_specialty ,Article Subject ,Endocrinology, Diabetes and Metabolism ,Levothyroxine ,030209 endocrinology & metabolism ,Newly diagnosed ,Gastroenterology ,Diseases of the endocrine glands. Clinical endocrinology ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Internal medicine ,medicine ,Statistical analysis ,Endocrine and Autonomic Systems ,business.industry ,Active principle ,RC648-665 ,Regimen ,Before Breakfast ,030220 oncology & carcinogenesis ,Postsurgical hypothyroidism ,Life study ,business ,Research Article ,medicine.drug - Abstract
Objective. Hypothyroid patients are treated by sodium levothyroxine (LT4). Tablet is the mostly used LT4 formulation, and the fasting regimen is required for the absorption of active principle. Also, gastrointestinal diseases and drugs may impair the LT4 bioavailability when tablet is used. Nonsolid LT4 formulations (i.e., liquid solution (LS) and soft gel (SG) capsule) were manufactured to overcome the limitations of LT4 tablet. This study was conceived to evaluate the performance of nonsolid LT4 formulations in a real-life scenario. Methods. Two institutions participated in the study that was conducted in two phases (i.e., enrollment and re-evaluation). Adults with autoimmune or postsurgical hypothyroidism and on LT4 from a few months were selected. A nonparametric statistical analysis for paired or unpaired data was performed. Results. 121 consecutive cases were included. At the enrollment phase, a 52% of patients took the therapy at least 30 min before breakfast with no difference between tablet and SG/LS users. TSH was 1.65 mIU/L (0.86–2.70) in patients on LT4 tablet and 1.70 mIU/L (1.10–2.17) in those on SG/LS (p=0.66). At the re-evaluation phase, among the patients using correct LT4 assumption, the TSH value was stable in the tablet group (p=0.22) and significantly reduced in SG/LS group (p=0.004); among the patients using incorrect LT4 assumption, TSH was significantly increased in those on tablet (p=0.0029) and stable in those on SG/LS (p=0.36). Conclusion. The performance of nonsolid LT4 formulations is not influenced by correct or incorrect use of therapy. On the contrary, LT4 tablet does not guarantee euthyroidism when it is ingested without waiting for at least 30 minutes before breakfast. These new data, obtained in a real-life scenario, suggest that LT4 SG/LS should be regarded as first-line therapy for treating adults with newly diagnosed hypothyroidism.
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- 2020
39. Assessment of Neuroendocrine Changes and the Hypothalamo-Pituitary Autoimmunity in Patients With COVID-19
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Basak Ecem Bircan, Annamaria De Bellis, Paolo Cirillo, Fahrettin Kelestimur, Serdar Sahin, Cem Sulu, Miriam Longo, Hande Mefkure Ozkaya, Giuseppe Bellastella, Emre Durcan, Fatma Ferda Kartufan, Mustafa Sait Gonen, Lorenzo Scappaticcio, and Dildar Konukoglu
- Subjects
Coronavirus disease 2019 (COVID-19) ,business.industry ,Immunology ,Medicine ,In patient ,business ,medicine.disease_cause ,Autoimmunity - Abstract
Purpose: The SARS-CoV-2 may affect the hypothalamic-pituitary axis and pituitary dysfunction may occur. Therefore, we investigated neuroendocrine changes, particularly, secondary adrenal insufficiency using a dynamic test and the role of autoimmunity in pituitary dysfunction in the patients with COVID-19.Methods: The single-center, prospective, case-control study included PCR-confirmed COVID-19 patients and healthy controls. Basal hormone levels were measured and ACTH stimulation test was performed. Anti-pituitary (APA) and anti-hypothalamic antibodies (AHA) were also determined. Results: We examined a total of 49 patients with COVID-19 and 28 healthy controls. The frequency of adrenal insufficiency in patients with COVID-19 was found as 8.2%. The patients with COVID-19 had lower free T3, IGF-1, total testosterone levels, and higher cortisol and prolactin levels when compared with controls. We also, demonstrated the presence of APA in three and AHA in one of four patients with adrenal insufficiency. Conclusions: The COVID-19 may result in adrenal insufficiency, so the routine screening of adrenal functions is these patients is needed. Endocrine disturbances in COVID-19 are similar to those seen in acute stressful conditions or infections. Also, pituitary or hypothalamic autoimmunity may play a role in neuroendocrine abnormality in COVID-19.
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- 2021
40. GLP-1 receptor agonists and cardiorenal outcomes in type 2 diabetes: an updated meta-analysis of eight CVOTs
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Antonio Ceriello, Miriam Longo, Katherine Esposito, Giuseppe Bellastella, Paola Caruso, Dario Giugliano, Lorenzo Scappaticcio, Maria Ida Maiorino, Paolo Chiodini, Giugliano, D., Scappaticcio, L., Longo, M., Caruso, P., Maiorino, M. I., Bellastella, G., Ceriello, A., Chiodini, P., and Esposito, K.
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Male ,Endocrinology, Diabetes and Metabolism ,Type 2 diabetes ,Cardiovascular outcome trials ,Risk Factors ,Efpeglenatide ,Cause of Death ,Original Investigation ,Clinical Trials as Topic ,Incidence ,Hazard ratio ,Cardiorenal outcome ,Middle Aged ,GLP-1RA ,Hospitalization ,Treatment Outcome ,Cardiovascular Diseases ,Female ,Kidney Diseases ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,Oral semaglutide ,Lixisenatide ,Placebo ,Incretins ,Risk Assessment ,Glucagon-Like Peptide-1 Receptor ,Albiglutide ,Diabetes mellitus ,Internal medicine ,medicine ,Humans ,Hypoglycemic Agents ,Diseases of the circulatory (Cardiovascular) system ,Dulaglutide ,Aged ,Cardio-Renal Syndrome ,business.industry ,Cardiorenal outcomes ,Semaglutide ,Liraglutide ,medicine.disease ,Confidence interval ,Cardiovascular outcome trial ,Diabetes Mellitus, Type 2 ,RC666-701 ,Heart failure ,Exenatide ,business ,Mace - Abstract
Background A meta-analysis is presented of cardiovascular outcome trials (CVOTs) comparing glucagon-like peptide-1 receptor agonists (GLP-1RA) versus placebo on cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM). Methods We did an electronic search up to June 30, 2021, for eligible trials. We did a meta-analysis of available trial data using a random-effects model to calculate overall hazard ratios (HRs) and 95% CI (confidence intervals). We included data from 8 CVOTs and 60,080 patients (72.4% with established cardiovascular disease). Results GLP-1RA reduced major cardiovascular events (MACE) by 14% (HR = 0.86, 95% CI 0.79–0.94, P = 0.006) with a non-significant heterogeneity between subgroups of patients with and without cardiovascular disease (P = 0.127). GLP-1RA also reduced the risk of cardiovascular death by 13% (P = 0.016), nonfatal stroke by 16% (P = 0.007), hospitalization for heart failure by 10% (P = 0.023), all-cause mortality by 12% (P = 0.012), and the broad composite kidney outcome by 17% (P = 0.012), which was driven by a reduction in macroalbuminuria only (HR = 0.74, 0.67–0.82, P Conclusions GLP-1RA have moderate benefits on MACE, and also reduce hospitalization for heart failure and all-cause mortality; they also have robust benefits on reducing the incidence of macroalbuminuria.
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- 2021
41. Glycemic Control and the Heart: The Tale of Diabetic Cardiomyopathy Continues
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Miriam Longo, Lorenzo Scappaticcio, Paolo Cirillo, Antonietta Maio, Raffaela Carotenuto, Maria Ida Maiorino, Giuseppe Bellastella, Katherine Esposito, Longo, M., Scappaticcio, L., Cirillo, P., Maio, A., Carotenuto, R., Maiorino, M. I., Bellastella, G., and Esposito, K.
- Subjects
Diabetic Cardiomyopathies ,Heart failure ,Type 2 diabetes ,Heart ,Diabetic cardiomyopathy ,Glycemic Control ,Cardiovascular disease ,Biochemistry ,Diabetes Mellitus, Type 2 ,Hyperglycemia ,Glucose control ,Humans ,Glucose-lowering agent ,Molecular Biology - Abstract
Cardiovascular diseases are the leading cause of death in people with diabetes. Diabetic cardiomyopathy (DC) is an important complication of diabetes and represents a distinct subtype of heart failure that occurs in absence of cardiovascular diseases. Chronic hyperglycemia and hyperinsulinemia along with insulin resistance and inflammatory milieu are the main mechanisms involved in the pathophysiology of DC. Changes in lifestyle favoring healthy dietary patterns and physical activity, combined with more innovative anti-diabetes therapies, are the current treatment strategies to safeguard the cardiovascular system. This review aims at providing an updated comprehensive overview of clinical, pathogenetic, and molecular aspects of DC, with a focus on the effects of anti-hyperglycemic drugs on the prevention of pump dysfunction and consequently on cardiovascular health in type 2 diabetes.
- Published
- 2021
42. The dilemma of 18F-FDG PET/CT thyroid incidentaloma: what we should expect from FNA. A systematic review and meta-analysis
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Lorenzo Scappaticcio, Giorgio Treglia, David N. Poller, Pierpaolo Trimboli, and Arnoldo Piccardo
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Incidentaloma ,Thyroid ,030209 endocrinology & metabolism ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,medicine.anatomical_structure ,Cytopathology ,Biopsy, Fine-Needle ,Fluorodeoxyglucose F18 ,Humans ,Positron Emission Tomography Computed Tomography ,Retrospective Studies ,Thyroid Neoplasms/diagnostic imaging ,Thyroid Nodule/diagnostic imaging ,18F-FDG ,Bethesda ,FNA ,PET/CT incidentaloma ,Thyroid cancer ,030220 oncology & carcinogenesis ,Internal medicine ,Meta-analysis ,Cytology ,medicine ,Fdg pet ct ,business ,Cancer prevalence - Abstract
Purpose 18F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35–40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal 18F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of 18F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories. Methods Original studies reporting 18F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of 18F-FDG TIs in the six BETHESDA subcategories. Results Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of 18F-FDG TIs according to BETHESDA was BETHESDA I 10% (6–14), BETHESDA II 45% (37–53), BETHESDA III 8% (3–13), BETHESDA IV 8% (5–12), BETHESDA V 6% (4–9), BETHESDA VI 19% (13–25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies. Conclusion Two-thirds of focal 18F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.
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- 2021
43. Up and down waves of glycemic control and lower-extremity amputation in diabetes
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Katherine Esposito, Maria Ida Maiorino, Dario Giugliano, Paola Caruso, Lorenzo Scappaticcio, Caruso, P., Scappaticcio, L., Maiorino, M. I., Esposito, K., and Giugliano, D.
- Subjects
Blood Glucose ,medicine.medical_specialty ,Time Factors ,National Health and Nutrition Examination Survey ,Time Factor ,Diabetic Angiopathie ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Type 2 diabetes ,Glycemic Control ,030204 cardiovascular system & hematology ,Placebo ,Risk Assessment ,Amputation, Surgical ,03 medical and health sciences ,Peripheral Arterial Disease ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Diabetes Mellitus ,Diseases of the circulatory (Cardiovascular) system ,Humans ,Hypoglycemic Agents ,Amputation ,Glycemic ,Hypoglycemic Agent ,Liraglutide ,business.industry ,Semaglutide ,Risk Factor ,Diabetes Mellitu ,Biomarker ,medicine.disease ,Blood pressure ,Treatment Outcome ,Lower Extremity ,RC666-701 ,Commentary ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Diabetic Angiopathies ,medicine.drug ,Human - Abstract
Lower extremity amputations (LEA) are associated with a high mortality and medical expenditure. Diabetes accounts for 45% to 70% of LEA and is one of the most potent risk factors for peripheral artery diseases (PAD). The existence of a link between the recent relaxation of glycemic targets and the resurgence of LEA is suggested from the analysis of adult participants in the National Health and Nutrition Examination Survey (NHANES) between 2010 and 2015, when diabetes-related LEA increased by more than 25% associated with a decline in glycemic control. Indeed, in “the perfect wave” of NHANES, including the years 2007–2010, there was the highest number of diabetic people with hemoglobin A1c (HbA1c), non-high-density lipoprotein (HDL) cholesterol and blood pressure levels at their respective targets, associated with the lowest number of LEA. Until now, the ACCORD study, testing the role of aggressive vs conventional glucose control, and the LEADER trial, evaluating the effects of liraglutide versus placebo, have shown a reduced incidence of LEA in people with type 2 diabetes. The results of ongoing clinical trials involving glucagon-like peptide-1 receptor agonists (GLP-1RA, liraglutide or semaglutide) hopefully will tell us whether the wider use of these drugs may provide additional vascular benefits for diabetic people affected by PAD to decrease their risk of LEA.
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- 2021
44. Mediterranean diet in type 2 diabetes: An updated overview of pharmacological activities of cardiometabolic and reproductive outcomes
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Mariangela Caputo, Miriam Longo, Katherine Esposito, Maria Ida Maiorino, Lorenzo Scappaticcio, Longo, M., Scappaticcio, L., Caputo, M., Maiorino, M. I., and Esposito, K.
- Subjects
Pharmacology ,Male ,Mediterranean diet ,business.industry ,MEDLINE ,Context (language use) ,Type 2 diabetes ,medicine.disease ,Diet, Mediterranean ,Cardiovascular System ,Diabetes Mellitus, Type 2 ,Cardiovascular Diseases ,Diabetes mellitus ,Environmental health ,Cardiovascular Disease ,Drug Discovery ,Medicine ,Humans ,Female ,business ,Glycemic ,Reproductive health ,Human - Abstract
Mediterranean diet represents an optimal "way of living" to pursue in order to preserve health and well-being. A large body of evidence indicates that the Mediterranean diet is effective in preventing diabetes and improving both glycemic control and cardiometabolic health in people with type 2 diabetes. Moreover, in the recent years a growing interest risen on the importance of dietary style choice in both male and female sexual and reproductive health. This review aims at providing an updated overview of the latest available evidence on the effects of Mediterranean diet on cardiovascular, metabolic, and reproductive health in the context of type 2 diabetes.
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- 2021
45. Alemtuzumab-induced thyroid events in multiple sclerosis: a systematic review and meta-analysis
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Marco Castellana, Luca Giovanella, S. Cannavò, Marco Centanni, Giuseppe Bellastella, Lorenzo Scappaticcio, Camilla Virili, Alfredo Campennì, R. Ruggeri, and Pierpaolo Trimboli
- Subjects
medicine.medical_specialty ,endocrine system diseases ,Endocrinology, Diabetes and Metabolism ,030209 endocrinology & metabolism ,Spontaneous remission ,Disease ,multiple sclerosis ,thyroid ,03 medical and health sciences ,Antineoplastic Agents, Immunological ,0302 clinical medicine ,Endocrinology ,Antithyroid Agents ,alemtuzumab ,side effects ,Internal medicine ,Humans ,Medicine ,In patient ,Randomized Controlled Trials as Topic ,business.industry ,Multiple sclerosis ,Thyroid ,medicine.disease ,Thyroid Diseases ,Confidence interval ,Observational Studies as Topic ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Meta-analysis ,Alemtuzumab ,business ,medicine.drug - Abstract
Autoimmune thyroid events (ATEs) are common side effects after alemtuzumab (ALZ) therapy in patients with multiple sclerosis (MS). Our purpose was to reach more robust evidence on prevalence and outcome of the spectrum of alemtuzumab-induced autoimmune thyroid events in patients with multiple sclerosis. PubMed and Scopus were systematically searched through July 2019. Studies dealing with patients without personal history of thyroid dysfunctions and affected by MS treated with ALZ and reporting ATEs were selected. Data on prevalence and outcome of ATEs were extracted. A proportion of meta-analysis with random-effects model was performed. Considering the overall pooled number of 1362 MS patients treated with ALZ (seven included studies), a 33% prevalence of newly diagnosed ATEs was recorded. Among all ATEs, Graves’ disease (GD) was the most represented [63% of cases, 95% confidence interval (CI) 52–74%], followed by Hashimoto thyroiditis (15%, 95% CI 10–22%). Interestingly, GD showed a fluctuating course in 15% of cases (95% CI 8–25%). Of all GD, 12% (95% CI 2–42%) likely had spontaneous remission, 56% (95% CI 34–76%) required only antithyroid drugs, 22% (95% CI 13–32%) needed additional RAI, and 11% (95% CI 0.9–29%) underwent definitive surgery. Among different categories of ATEs, Graves’ hyperthyroidism was the most common thyroid dysfunction, occurring in more than half of cases. Antithyroid drugs should represent the first-line treatment for ALZ-induced GD patients. However, alemtuzumab-induced GD could not be considered as having a more favourable outcome than conventional GD, given the substantial chance to encounter a fluctuating and unpredictable course.
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- 2019
46. The dilemma of
- Author
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Lorenzo, Scappaticcio, Arnoldo, Piccardo, Giorgio, Treglia, David N, Poller, and Pierpaolo, Trimboli
- Subjects
18F-FDG ,Fluorodeoxyglucose F18 ,FNA ,Bethesda ,Positron Emission Tomography Computed Tomography ,Biopsy, Fine-Needle ,Humans ,Thyroid Neoplasms ,Thyroid Nodule ,PET/CT incidentaloma ,Thyroid cancer ,Retrospective Studies ,Meta-Analysis - Abstract
Purpose 18F-FDG thyroid incidentaloma (TI) occurs in ~2% of PET/CT examinations with a cancer prevalence of up to 35–40%. Guidelines recommend fine-needle aspiration cytology (FNA) if a focal 18F-FDG TI corresponds to a sonographic nodule >1 cm. The aim of this systematic review and meta-analysis was to provide evidence-based data on the diagnostic distribution of 18F-FDG TIs in the six Bethesda systems for reporting thyroid cytopathology (BETHESDA) subcategories. Methods Original studies reporting 18F-FDG TIs and cytologically classified according to BETHESDA were included. Six separate meta-analyses were performed to obtain the pooled prevalence (95% confidence interval, 95% CI) of 18F-FDG TIs in the six BETHESDA subcategories. Results Fifteen studies were finally included. Nine studies were from Asian/Eastern and six from Western countries. FNA data according to BETHESDA was available in 2304 cases. The pooled prevalence of 18F-FDG TIs according to BETHESDA was BETHESDA I 10% (6–14), BETHESDA II 45% (37–53), BETHESDA III 8% (3–13), BETHESDA IV 8% (5–12), BETHESDA V 6% (4–9), BETHESDA VI 19% (13–25). A significantly different prevalence was found in the BETHESDA IV between Asian/Eastern (2%) and Western (19%) studies. Conclusion Two-thirds of focal 18F-FDG TIs undergoing FNA have either malignant (BETHESDA VI) or benign (BETHESDA II) cytology while a minority will have indeterminate (BETHESDA III or IV) FNA results. Significant differences between Asian/Eastern and Western studies are also present in the prevalence of indeterminate FNA results.
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- 2021
47. New insights into vitamin D regulation: is there a role for alkaline phosphatase?
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Antonietta Maio, Lorenzo Scappaticcio, Miriam Longo, Paola Caruso, Maria Ida Maiorino, Maria Teresa Vietri, Vanda Amoresano Paglionico, Katherine Esposito, Giuseppe Bellastella, R. Carotenuto, Carla Carbone, Bellastella, G., Scappaticcio, L., Longo, M., Carotenuto, R., Carbone, C., Caruso, P., Maio, A., Paglionico, V. A., Vietri, M. T., Maiorino, M. I., and Esposito, K.
- Subjects
Adult ,Male ,Vitamin ,medicine.medical_specialty ,Adolescent ,Bilirubin ,Endocrinology, Diabetes and Metabolism ,Direct bilirubin ,25-Hydroxyvitamin D ,030209 endocrinology & metabolism ,Bone and Bones ,vitamin D deficiency ,Young Adult ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Endocrinology ,Liver Function Tests ,Internal medicine ,medicine ,Vitamin D and neurology ,Animals ,Humans ,Vitamin D ,Aged ,Retrospective Studies ,030219 obstetrics & reproductive medicine ,medicine.diagnostic_test ,business.industry ,Healthy subjects ,25-Hydroxylase ,Middle Aged ,Alkaline Phosphatase ,Vitamin D Deficiency ,medicine.disease ,chemistry ,CYP2R1 ,Alkaline phosphatase ,Original Article ,Rabbits ,Liver function tests ,business - Abstract
Purpose The diagnosis of vitamin D deficiency is based on the determination of total plasma 25-hydroxyvitamin D (25-OHD) concentrations, but the regulation of vitamin D 25-hydroxylation is not a major consideration and very little information is available on this activity. To check what factors could interfere with the activity of vitamin D-25-hydroxylase and thus alter the 25-OHD concentrations, we looked for potential correlations between 25-OHD and results of liver function tests in healthy adults. Methods This single-centre study was retrospective and consisted of evaluating the correlations between 25-OHD and the activities of aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), and bone alkaline phosphatase (BALP) in 349 healthy subjects aged from 18 to 65 years. In particular, in Group 1 (n = 119), we looked for correlations between 25OHD and all liver function tests and in Group 2 (n = 230) the correlation between 25OHD and BALP. Results In Group 1, we found no correlation between 25OHD and AST (r = − 0.03; p = 0.8), ALT (r = − 0.02; p = 0.91), GGT (r = − 0.08; p = 0.68), direct bilirubin (r = − 0.02; p = 0.89), indirect bilirubin (r = − 0.24; p = 0.21), and total bilirubin (r = − 0.24; p = 0.21) but one between 25OHD and ALP (r = − 0.2; p = 0.007); in Group 2, we found a significant negative correlation between 25-OHD and BALP (r = − 0.2; p = 0.0008). Conclusions The correlations that we found suggest that ALP and BALP might be involved in the regulation of vitamin D-25-hydroxylase activity, but further studies are mandatory to confirm our assumptions.
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- 2021
48. Chronothyroidology: Chronobiological aspects in thyroid function and diseases
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Antonio Bellastella, Silvia Mercadante, Lorenzo Scappaticcio, Annamaria De Bellis, Katherine Esposito, Giuseppe Bellastella, Maria Ida Maiorino, Bellastella, G., Maiorino, M. I., Scappaticcio, L., De Bellis, A., Mercadante, S., Esposito, K., and Bellastella, A.
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0301 basic medicine ,Science ,030209 endocrinology & metabolism ,Review ,Biology ,General Biochemistry, Genetics and Molecular Biology ,03 medical and health sciences ,0302 clinical medicine ,Rhythm ,medicine ,Circadian rhythm ,Ecology, Evolution, Behavior and Systematics ,Ultradian rhythm ,Chronobiology ,Biological rhythm ,Suprachiasmatic nucleus ,Thyroid ,Paleontology ,Rhythm disruption ,Thyroid diseases ,biological rhythms ,030104 developmental biology ,medicine.anatomical_structure ,Space and Planetary Science ,Thyroid function ,Neuroscience ,Hormone - Abstract
Chronobiology is the scientific discipline which considers biological phenomena in relation to time, which assumes itself biological identity. Many physiological processes are cyclically regulated by intrinsic clocks and many pathological events show a circadian time-related occurrence. Even the pituitary–thyroid axis is under the control of a central clock, and the hormones of the pituitary–thyroid axis exhibit circadian, ultradian and circannual rhythmicity. This review, after describing briefly the essential principles of chronobiology, will be focused on the results of personal experiences and of other studies on this issue, paying particular attention to those regarding the thyroid implications, appearing in the literature as reviews, metanalyses, original and observational studies until 28 February 2021 and acquired from two databases (Scopus and PubMed). The first input to biological rhythms is given by a central clock located in the suprachiasmatic nucleus (SCN), which dictates the timing from its hypothalamic site to satellite clocks that contribute in a hierarchical way to regulate the physiological rhythmicity. Disruption of the rhythmic organization can favor the onset of important disorders, including thyroid diseases. Several studies on the interrelationship between thyroid function and circadian rhythmicity demonstrated that thyroid dysfunctions may affect negatively circadian organization, disrupting TSH rhythm. Conversely, alterations of clock machinery may cause important perturbations at the cellular level, which may favor thyroid dysfunctions and also cancer.
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- 2021
49. Renal and metabolic effects of SGLT-2i and DPP-4i according to basal estimated glomerular filtration rate: Analysis from GIOIA, an observational prospective study
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Katherine Esposito, Giuseppe Bellastella, Miriam Longo, Luca De Nicola, Maria Ida Maiorino, Lorenzo Scappaticcio, Longo, M., Scappaticcio, L., Maiorino, M. I., De Nicola, L., Bellastella, G., and Esposito, K.
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medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Urology ,Renal function ,Type 2 diabetes ,DPP-4i ,Kidney ,Type 2 diabete ,Basal (phylogenetics) ,Endocrinology ,Kidney function ,Diabetes mellitus ,Internal Medicine ,medicine ,eGFR ,Humans ,Prospective Studies ,Prospective cohort study ,Sodium-Glucose Transporter 2 Inhibitors ,Dipeptidyl-Peptidase IV Inhibitors ,business.industry ,General Medicine ,SGLT-2i ,medicine.disease ,Prospective Studie ,Diabetes Mellitus, Type 2 ,Metabolic effects ,Dipeptidyl-Peptidase IV Inhibitor ,Observational study ,business ,Glomerular Filtration Rate ,Human - Abstract
In the GIOIA study, users of both SGLT-2i and DPP-4i improved glycometabolic control, after 12 months, independently from baseline eGFR levels. Moreover, both classes led to a significant decrease in eGFR in participants with eGFR ≥ 90 ml/min/1.73 m2 and no deterioration in case of mild impairment of renal function.
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- 2021
50. Sodium–glucose transporter-2 inhibitors for prevention and treatment of cardiorenal complications of type 2 diabetes
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Miriam Longo, Lorenzo Scappaticcio, Paola Caruso, Katherine Esposito, Dario Giugliano, Giugliano, D., Longo, M., Scappaticcio, L., Caruso, P., and Esposito, K.
- Subjects
Blood Glucose ,medicine.medical_specialty ,lcsh:Diseases of the circulatory (Cardiovascular) system ,Diabetic Cardiomyopathies ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Heart failure ,Type 2 diabetes ,Glycemic Control ,Review ,MACE ,Risk Assessment ,Class effect ,Age ,Primary and secondary prevention ,Risk Factors ,Diabetes mellitus ,Internal medicine ,medicine ,Secondary Prevention ,Humans ,Diabetic Nephropathies ,Myocardial infarction ,Diabetic kidney disease ,Stroke ,Sodium-Glucose Transporter 2 Inhibitors ,Glycated Hemoglobin ,business.industry ,SGLT-2 inhibitors ,medicine.disease ,Natural history ,Primary Prevention ,Treatment Outcome ,Amputation ,Diabetes Mellitus, Type 2 ,lcsh:RC666-701 ,SGLT-2 inhibitor ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,Kidney disease - Abstract
Hospitalization for major diabetes complications, including myocardial infarction, stroke, lower-extremity amputation, and end-stage kidney disease, is on the rise and represents a great health burden for patients with type 2 diabetes (T2D), in particular for older people. Newer glucose-lowering medications have generated some optimism on the possibility to influence the natural history of cardiorenal complications of T2D. This review summarizes work in the area of sodium–glucose cotransporter 2 inhibitors (SGLT-2i) treatment and prevention of cardiorenal complications in patients with T2D (major adverse cardiovascular events, hospitalization for heart failure, kidney outcomes), with a particular emphasis on the effect of age, the role of primary versus secondary prevention and the possible extension of their cardiorenal benefits to the entire class of SGLT-2i.
- Published
- 2021
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